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HomeMy WebLinkAboutProcession - Fraternal Order of Police #36I --------------- --------------- 9L I. INTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE SENT: 6/30/2017 TO: skier, Traffic & Lighting �F erico Rodriguez, Fire Department pit Longfellow, Engineering ti•Kara Wood, Park Department Gene Eyster, Police Department ciccitano, Downtown South Bend Marcia Qualls, Streets Legal Department FROM: Linda M. Martin, Clerk _6� SUBJECT: PROCESSION RECOMMENDATION -Fallen Officer Scholarship Ride SPONSOR: Fraternal Order of Police #6 DATE OF EVENT: August 5 2017 12.00 m-5:00 m DATE DUE: July 3. 2017 FAX OR E-MAIL TO: 236-9171 1 Imartin southbendin. ov RECOMMENDATIONS AND COMMENTS: By Date 0 PERMIT/AGREEMENT FOR A PROCESSION 1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 2. Sponsor shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 3. Sponsor shall provide to the Board all additional licenses, permits and documentation required for the event. 4. Sponsor agrees to abide by all terms and conditions of the Board's policy governing walks, runs, parades or other similar event adopted by the Board on March 3, 1985. 5. In order to ensure public safety during the event, the Board agrees to furnish traffic planning, materials, equipment and personnel as deemed necessary by the Police Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Commissioners. 6. Sponsor acknowledges that the Police Department reserves the right to change this route for safety purposes. 7. In consideration for approval by the Board and the use of the sidewalks for the purposes set out above, the undersigned agrees and undertakes to hold the Civil City of South Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or expenses, including attorney fees, which the Civil City of South Bend may suffer or incur, as a result of any claims or actions which may be made by any person, including a participant in said activity, arising out of the approval of the request to use the sidewalks indicated in the City of South Bend. The undersigned certifies that he/she is authorized to bind the above mentioned sponsor to the terms hereof. 8. Notifrcation of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works I understand the above rules and regulations and that this application may be denied based on any false or incomplete mfor ion. Sponsor Signature Printed Name Ge llins Title Event Coordinator BOARD OF PUBLIC WORKS APPROVAL President Member Member 1L� 5 0-01-7 Me ber Member Date RETURN FORM TO: 2 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone; (574) 235-9251 • Fax: (574) 235-9171 0 E-Mail: publicwks@southbendin,gov obw =="mom, wjmmim�� A/eO0 CERTIFICATE OF LIABILITY INSURANCE DATEiMMfOplYYYYI s/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER STAR Insurance — Huntington Office TACT NAMEChuck Kennedy PHONE (260)356-3313 FAQ o:(260)356--3764 400 Frontage Rd L-mmi_S angela.e,ltzroth@starfinancial.Com INSURER{SJ AFFORDING COVERAGE NAIC # INSURERA:Creative Underwriter 0088 Huntington IN 46750 INSURED INSURER B : INSURERC: Fraternal Order Of Police, South Bend Lodge 36 INSURERD: PO BOX 299 INSURER E: t INSURER F : South Bend IN 46624 COVERAGES CERTIFICATE NUMBER:2017-2018 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM100fYYYY POLICY EXP M 1pD1YYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX_11 OCCUR I CPS2532920 1/7/2017 1/7/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) 3 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY � PE Q LOC [ OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COIa1P10P AGO $ 2,000,000 Property damage -single linid S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS I I l ` COhiBcclINEO en1 SINGLE LIMIT 5 $ BODILY INJURY (Per person) 5 BODILY INJURY (Per accident)$ I PROPERTY DAthAGE Per acddenl S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE ' € EACH OCCURRENCE S AGGREGATE 5 DED E RETENTIONS I S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 'ANY PROPRIETORIPARTNERIEXECUTIVE "' ' OFRCERIMEMBER EXCLUDED? {Mandatory In NHI If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. N/A ; I PER OTH- STATUTE i ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S DISEASE -POLICY LIMIT $ { I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) Fallen Officer Ride being held August 5, 2017 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES aE CANCELLED BEFORE City of South Bend 227 W Jefferson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Bend, IN 46601 AUTHORIZED REPRESENTATIVE Chuck Kennedy/AE ACORD 25 (2014/01) INSn76 r.)nIenir ©1988-2014 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD